Leptospirosis

Question 1

Etiology of leptospirosis

Answer 1

Spirochetes, Leptospira interrogans, highly motile

Question 2

Most important reservoir of leptospirosis

Answer 2

Rats

L.interrogans serovar Copenhageni

Question 3

Phase when organisms proliferate, cross tissue barriers, disseminate hematogenously to different organs

Answer 3

Leptospiremic phase

+ Blood culture

Question 4

Phase when antibodies appeare and coincides with the disappearance of leptospires

Answer 4

Immune phase

+ Urine culture

Question 5

Leptospira virulence factor

Answer 5

loa22

Question 6

Incubation period

Answer 6

1-2 weeks

Question 7

Triad of Weil’s syndrome

Answer 7

Hemorrhage
Jaundice
AKI

Question 8

Presentation of leptospiral nephropathy

Answer 8

Urinary losses of magnesium

Question 9

Cardiac findings which are poor prognostic signs

Answer 9

repolrization abnormalities

arrhythmias

Question 10

Long-term sequela of leptospirosis

Answer 10

Autoimmune uveitis

Question 11

Definitive diagnosis

Answer 11

Gold standard: Culture and isolation (6-8 weeks for result)

PCR-can confirm the dx in the first 5 days

Indirect method:
MAT(1:1600 is diagnostic)

Question 12

Treatment for mild lepto

Answer 12

Doxycycline 
or
Amoxicillin
or
Ampicillin

Question 13

Moderate to Severe Lepto treatment

Answer 13

Penicillin
or
Ceftriaxone 
or
Cefotaxime
or
Doxycycline

Question 14

Clinical manifestations should alert a health practitioner to suspect leptospirosis among patients presenting with acute fever?

Answer 14

acute febrile illness of at least 2 days

AND either residing in a flooded area or has high-risk exposure

AND presenting with at least two of the following symptoms: myalgia, calf tenderness, conjunctival suffusion, chills, abdominal pain, headache, jaundice, or oliguria should be considered a suspected leptospirosis case

Question 15

Pre-exposure prophylaxis

Answer 15

Doxycycline (hydrochloride and hyclate) 200 mg once weekly, to begin 1 to 2 days before exposure and continued throughout the period of exposure

Question 16

Post exposure prophylaxis for low risk

Answer 16

Doxycycline 200 mg single dose within 24 to 72 hours from exposure

Question 17

Post exposure prophylaxis for moderate risk

Answer 17

Doxycycline 200 mg once daily for 3-5 days to be started immediately within 24 to 72 hours from exposure

Question 18

Post exposure prophylaxis for high risk

Answer 18

Doxycycline 200 mg once weekly until the end of exposure

Question 19

Clinical features of AKI due to leptospirosis

Answer 19

mild proteinuria to severe anuric acute renal failure

Commonly it may present as non-oliguric renal failure with mild hypokalemia

Oliguria with hyperkalemia may reflect the severity of AKI and may connote poor prognosis

Question 20

Indications for acute renal replacement therapy or dialysis

Answer 20

Any one of the following

a. Uremic symptoms – Nausea, vomiting, altered mental status, seizure, coma
b. Serum creatinine > 3mg /dL
c. Serum K > 5 meq /L in an oliguric patient
d. ARDS, pulmonary hemorrhage
e. pH < 7.2
f. Fluid overload
g. Oliguria despite measures following the algorithm

Question 21

First sign of pulmonary involvement

Answer 21

Tachypnea

Question 22

Pulmonary symptoms appear

Answer 22

4th-6th day

Question 23

MC pulmo complications of lepto

Answer 23

Pulmo hemorrhage

ARDS